| Objective: Acute Myocardial Infarction has become one of the serious disease to human health.In recent years , Facilitated Percutaneous Coronary Intervention has emerged as a new method for AMI.In order to explore the feasibility of FPCI,in this study ,We contrasted facilitated PCI with primary PCI from the effect on the success rate of PCI, hemorrhage event of two groups after PCI in hospital and left ventricular remolding between different position of AMI. Then we followed up the clinical event of two groups in 1 year and observed the prognosis.Provided FPCI ,a more rational strategy of perfusion treatment for AMI patients.Methods: From March 2005 to March 2006,one hundred and fourty-two patients with primary AMI were divided into two group, All patients had persistent angina for more than 30 minutes ,ST-segment elevation of at least 0.1 mV in two or more extremity leads or at least 0.2 mV in two or more pre-cordial leads and the cardiac enzyme peak beyond two folds of normal range,the presence of symptoms for <6h, or<12h but ST-segment keep elevation and has chest pain,age<75years. Patients with the history of old myocardial infarction, severe heart failure,haemorrhagic stroke,ischaemic stroke< 6 months, peptic ulcer, uncontrolled hypertension, with hypersensitivity to rapamycin,disagree to CAG, IRA was left main vessel were all excluded.FPCI group 67 cases,average age was(62.5±9.3) year,47male,20 female. and primary PCI group75 cases. average age was(60.7±9.6)year,54 male,21 female .All the patients first received basic therapy,for example, oxygenate, calm,then 300mg of aspirine and 300mg of Clopidogrel Sulfate Tablets. The primary PCI group were under angiography without thrombolysis,while the FPCI group were under an intravenous drip of 5000u heparin ,followed by 29mg rt-PA(intravenous bolus of 8mg recombined rt-PA,then followed by 21mg).When there was the phenomenon of no-reflow, long disease vessel ,the Tirofiban Hydrochloride and Sodium Chloride Injection (intravenous bolus of 10ug/kg in three minies, then followed by 21mg 0.15ug/kg/min), and heparin was administered at the dose of 600-1000u/h for 36 hours,the APTT was measured for 1/6h,the APTT value was set at 50-70s.The residual stenosis of IRA>70% were implanted with stents. The standard of success is residual stenosis of IRA <20% and TIMI 3 flow. All patients were received routine medications of PCI, Beta-blocker, ACEa-Inhibitors etal.we collected clinical information detailed including:year, sex, risk factors,the mean interval from onset to PCI and thecomplications and mortality in-hospital. According to the different location of myocardial infarction , 142 patients were divided into anterior AMI and inferior AMI subgroups,At one week and eight weeks after PCI, Echocardiography was applied to observe the changes of parameters of Left Ventricular End Diastolic Volume Index,Left Ventricular End Systolic Volume Index,Left Ventricular Ejection Fraction.The Mean Ischemic Scores and myocardial infarction area were measured by 99mTc– MIBI eight weeks after PCI.The follow-up period was 12 months,observed the cardiac dysfunction, death due to primary cardiac cause et al. Compared the left ventricular remolding and prognosis between two groups.At the same time, also compared the left ventricular remolding and prognosis between subgroups groups.Results: 1. There was not significant differences about the mean interval from onset to the hospital between facilitated PCI group and primary PCI group [(7.1±3.5)h vs (6.9±4.2) h , P>0.05]; from arrival at hospital to first balloon inflation [(82.4±9.7)min vs (80.6±10.3)min,P>0.05],the time arrival at hospital to admitted to ethrombolytic was(23.7±6.4)min. 2.At the CAG the patients with TIMI 3 flow were more in the facilitated PCI group(32.8%vs2.7%,P<0.05);3.The haemorrhage event were similar in two groups, [(11.9%)vs(10.7%), P>0.05].4. At eight weeks after PCI in facilitated PCI the area of myocardial infarction was similar to primary PCI, [(19.73±5.24)%, vs(20.34±5.61)%,p>0.05].At eight weeks after PCI in FPCI the LVEDVI,LVESVI ,LVEF ,was (63.1±8.2)ml/m2, (35.6±9.3)ml/m2, (54.5±7.9)%,in primary PCI group LVEDVI, LVESVI, LVEF was(64.6±7.0)ml/m2,(36.5±7.6)ml/m2,(53.5±6.6) %, there were of no significant differences between the two groups.5.The area of the anterior myocardial infarction was smaller in the facilitated PCI subgroups, [(20.21±3.24)% vs(22.25±4.35)%,P<0.05], but there were of no statistical differences in inferior AMI[(15.27±2.65)% vs(15.69±3.84)%,P>0.05]; After eight weeks of PCI, The LVEF of the anterior myocardial infarction was higher in the facilitated PCI group[ (56.9±8.5) % vs (50.5±5.6) % , P<0.05 ]; there were of no statistical differences in inferior AMI, LVEF[(58.9±7.5)% vs (59.2±7.8)%, P>0.05]. 6. The follow-up period was 12 months ,the heart function in anterior myocardial infarction of facilitated PCI NYHA I was 72.2%, NYHA II-IV was 27.8%, the anterior myocardial infarction in primary PCI group NYHA I was 48.7%, NYHA II-IV was 51.3%,P<0.05,there were of statistical differences in anterior AMI.Conclusions: 1 In the success rate of PCI and haemorrhage event, there were of no difference between the FPCI and Primary PCI.2 The facilitated PCI has the benefit on smaller anterior myocardial infarction area,better left Ventricular function and left ventricular remolding.3 The anterior myocardial infarction in facilitated PCI group has fewer cardiac dysfunction, the prognosis is better.
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